Are you one of over two million people in Canada who have received an Autoimmune Disease diagnosis? Could you be one of the millions more who will wait over a decade for that diagnosis while your myriad symptoms worsen?
There are over 100 different recognized autoimmune diseases and the incidence of these disorders is rising, sometimes markedly over even just the last five years. Autoimmune disease affects almost 10% of the population, with 78% of those affected being women.
There is a high rate of co-occurrence, where one diagnosis is followed by one or more additional autoimmune diagnoses over the ensuing years. The danger of additional diagnoses increases with autoimmune disease left untreated or undertreated. One autoimmune diagnosis makes it three times more likely you will develop another. There is also strong evidence of familial linkage, where a particular family may have a mother with Hashimoto’s Thyroiditis, a father Type 1 Diabetes, and children with psoriasis, Crohn’s disease or celiac; all distinct diseases that fall under the autoimmune umbrella.
Autoimmune diseases are notoriously difficult to diagnose. Symptoms are often vague and seemingly unrelated. What makes these conditions more difficult to diagnose and manage is that they are so poorly understood, even by specialists. The science and information changes so quickly as we learn more that it is almost impossible for a full time physician to stay ahead of the research. Additionally, once it does hit the research journals it can take 17 years to become accepted knowledge that is used in practice. That, my dears, is a slow rate of change!
The Autoimmune Thyroid Experience
Since our focus this month is Thyroid, let’s consider the typical hypothyroid symptoms: fatigue, mood dysregulation (anxiety or depression), hair loss, and wonky periods.
If a patient presents to their doctor with these symptoms, the doctor may do some perfunctory tests during an appointment and find blood pressure a little high, prompting them to run some basic blood work. Those results may show elevated cholesterol and perhaps low iron.
It is not unheard of for someone like this to come out of their doctor’s appointment with a prescription or two, perhaps a statin to lower cholesterol, or an antidepressant, maybe the birth control pill to make their cycle more regular, and advice to pick up an iron supplement at the pharmacy or big box store.
“But don’t worry,” they may assure you, “your thyroid is fine.” Fine?
There is nothing fine about any of this. None of the recommended treatments addresses the root cause of the symptoms, or does the deep digging to find the why of it all.
To paraphrase Clinical Nutritionist Josh Gitalis – If you have a stone in your shoe you don’t take pain medication, you deal with the stone!
What Is Autoimmune Disease?
In the same way that rheumatoid arthritis is not a joint disease and multiple sclerosis is not a nerve disease, Hashimoto’s and Grave’s disease are not thyroid diseases. They only look like it. The symptoms experienced in these tissues are not a flaw in the tissues themselves, but a flaw in the immune system that triggers the body to attack itself.
Conventional Treatment of Autoimmune Thyroid Disease
Unfortunately, most people who are lucky enough to receive this diagnosis are treated with a prescription of synthetic thyroid hormone, or radiation, which does not address the underlying autoimmunity.
I say “lucky enough” because while we now know upwards of 90% of hypothyroid may be undiagnosed Hashimoto’s; it is unlikely for this to be investigated by most doctors. Even many endocrinologists will depend solely on an elevated TSH (a pituitary hormone, NOT a thyroid hormone — more on this here) to determine if a patient is hypo or hyper thyroid.
Worse yet, if TSH is determined to be high and medication is prescribed, this same doctor may continue to use TSH to determine dosing, instead of a complete blood panel to measure thyroid hormone activity. The package insert for Synthroid, the most prescribed drug for several years states “Levothyroxine (Synthroid) is also effective in the suppression of pituitary TSH secretion”.
How is autoimmune thyroid disease missed so often?
Not looking at the thyroid in the first place. Those experiencing symptoms are often told they’re too young, it’s stress, their hormones, or when everything comes back “fine”, that it’s all in their head.
Not doing a complete thyroid panel. It is important to measure TSH along with Free T3 and Free T4.
Not looking at antibodies. A person can have elevated antibodies and thyroid symptoms for years before TSH is elevated.
Using outdated “normal” ranges instead of functional or optimal ranges. “Normal” an average, but the average person is often just sick and tired as the next person finding themselves at the blood lab. We want to strive for an optimal range that functions well for you.
Not understanding that a person can have an autoimmune thyroid condition without elevated TSH, elevated antibodies or even without a thyroid. Yes, really.
Focusing on other autoimmune conditions or diagnoses you already have.
Not looking for the root cause. Oftentimes chronic infection can cause irregularities in immune system which make the body more likely to fight itself than foreign invaders.
What To Do?
With autoimmune thyroid disease, the key to restoring proper function lies not just in managing the thyroid, but in managing the underlying autoimmune condition. Utilizing a unique to you combination of diet, lifestyle, supplementation and, if necessary, medication can reverse symptoms and help you regain your health.
To fully assess the health of your thyroid, and determine if you may have an autoimmune condition, we recommend working with a skilled Naturopathic Doctor and a Holistic Nutritionist, like myself, to help guide you on the path back to optimal health.
 Zoe Slote Morris, Steven Wooding, Jonathan Grant. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-520.